Behavioral Health

by

Denise Torres, Steve Estrine

• LAST REVIEWED: 26 February 2013
• LAST MODIFIED: 26 February 2013
• DOI: 10.1093/obo/9780195389678-0151

Introduction

As with mental health (see Oxford Bibliographies article on Mental Health), there is no one definition of behavioral health. Instead there are a number of competing definitions. Frequently, the term is used synonymously with “mental illness,” or, in a more expanded sense, as encompassing mental and substance use disorders and their respective service systems. This usage contrasts with the more specific name for an interdisciplinary approach to the prevention, treatment, rehabilitation, and support services for individuals across the continuum of health problems. In the latter, behavioral health refers to a state of physical, mental, and emotional well-being affected by individual choices and actions and the ways in which these are exercised. The term highlights the bidirectional nature of physical and mental health in individuals and the interaction between persons and their sociocultural environments. In practice, however, the term continues to evolve in response to philosophical and epistemological debates, emerging knowledge and research findings, and historical, cultural, political, and practice contexts. Given the variability in terms, this article will first clarify definitions of behavioral health. Behavioral health will be used specifically to refer to the more inclusive concept of wellness and well-being with behavioral health care capturing service delivery approaches that are moving toward holistic, integrated care for mental, physical, addictive, and psychosocial conditions. To promote clarity, mental health will refer to all psychological issues such as substance use, suicide, and mental disorders; physical health will stand for physiological conditions; and the term “social health” will speak to environmental and social factors such as homelessness or immigration status that impact physical and mental health. Behavioral health is consistent with the social work profession’s person-in-environment (PIE) or ecological approach, the biopsychosocial assessment, and the profession’s guiding values and ethics. The works cited in General Overviews connect this understanding to social work practice in the United States and internationally. The Historical Context section elaborates further on the economic, political, and social milieu promoting the shift to behavioral health internationally and in the United States.

General Overviews

The definitional fuzziness around behavioral health makes it difficult to find works that adequately cover health concerns (e.g., chronic pain, obesity, and smoking) and substance use and mental disorders from an integrated perspective. Many of the volumes available are specific to health promotion and education as a specialty. Thus, the works here were selected for their focus on the integration of health, mental health, and social health and their inclusion of casework, group work, policy, and/or administrative approaches. For individuals wanting a broad overview of the field of behavioral health in the United States, Rosenberg and Rosenberg 2006 underscores the need for integrated services and identifies approaches that promote and improve wellness and quality of life. The book is particularly insightful in grappling with the issue of consumers/client roles and how fragmented care systems perpetuate social injustice and exclusion for oppressed populations. Heller and Gitterman 2011 is well targeted to social work students, as it emphasizes the alignment between the dual mission of social work and behavioral health’s focus, underscores the contributions of environmental and social problems on health and quality of life, and addresses work with marginalized and vulnerable populations. Knapp, et al. 2007 provides insight into the mental health system in Europe and the differences and similarities among countries. The essays are particularly helpful in analyzing the role policy and financing has played in creating and maintaining social exclusion for vulnerable groups and in determining the services available. Jackson and Segal 2002, which presents papers from an international conference and covers behavioral health more globally, specifically addresses the role of the social work profession in research, practice, and education. Although a bit dated, the volume helps place the transformation of the various behavioral health-care systems within the context of macroenvironmental forces and pressures within each of the countries examined.

• Heller, N. R., and G. Gitterman, eds. 2011. Mental health and social problems: A social work perspective. New York: Routledge.

  Focuses on assisting undergraduate and graduate social work students in understanding the interactions between macrosocial problems—including poverty, war, and immigration—and various mental, emotional, and developmental disorders.

• Jackson, A. C., and S. P. Segal, eds. 2002. Social work health and mental health: Practice, research and programs. Binghamton, NY: Haworth.

  An expansive anthology of international articles addressing issues related to the integration of mental and physical wellness in social work practice including curriculum and workforce issues; practice settings and levels of intervention; and policy, administration, research, and practice.

• Knapp, M., D. McDaid, E. Mossialos, and G. Thornicroft, eds. 2007. Mental health policy and practice in Europe. New York: Open Univ. Press.

  After a thorough historical overview of mental health care in Europe, the essays in this anthology cover specific countries and address underlying themes of social exclusion, the interaction between health-care policy, financing, and services, and the need for greater advocacy among all stakeholders and constituencies.

• Rosenberg, J., and S. Rosenberg, eds. 2006. Community mental health: challenges for the 21st century. New York: Routledge.

  Provides a comprehensive overview of community behavioral health issues from a person-in-environment perspective and assists undergraduate and graduate students in understanding the population, sector, and policy landscape of practice.